Comparison of the Charlson comorbidity index, the modified Charlson comorbidity index, and the recipient risk score in prediction of the graft and patient survival among renal graft recipients: historical cohort in a single center.

OBJECTIVE: To compare the predictive values of Charlson comorbidity index (CCI), modified Charlson comorbidity index kidney transplant (mCCI-KT) and recipient risk score (RRS) indices in prediction of patient and graft survival in kidney transplant patients. METHODS: In this retrospective study, all patients who underwent a live-donor KT from 2006 to 2010, were included. Demographic data, comorbidities and survival time after KT were extracted and the association between above indices with patient and graft survival were compared. RESULTS: In ROC curve analysis of 715 included patients, all three indicators were weak in predicting graft rejection with the area under curve (AUC) less than 0.6. The best models for predicting the overall survival were mCCI-KT and CCI with AUC of 0.827 and 0.780, respectively. Sensitivity and specificity of mCCI-KT at cut point of 1 were 87.2 and 75.6. Sensitivity and specificity of CCI at cut point of 3 were 84.6 and 68.3 and for RRS at cut point of 3 were 51.3 and 81.2, respectively. CONCLUSION: The mCCI-KT index followed by the CCI index provided the best model in predicting the 10-year patient survival; however, they were poor in predicting graft survival and this model can be used for better stratifying transplant candidates prior to surgery.

Successful Repair of Bilateral Ureteral Stricture 3 Years after En Bloc Kidney Transplant: A Case Report.

En bloc kidney transplants of small pediatric kidneys into adult recipients have been shown to have outcomes similar to transplants from standard adult deceased donors. Here, we report a 27-year-old male patient with successful repair of bilateral ureteral stricture 3 years after en bloc kidney transplant at the Shahid Modarres Hospital (Tehran, Iran). The patient received an en bloc deceased kidney donation from a 9-month-old infant. An end-to-end anastomosis of the aorta to the internal iliac artery and an end-to-side external iliac vein anastomosis to vena cava were performed. At an outpatient visit about 2.5 years later, the patient showed increasing levels of creatinine from 1.1 to 1.8 mg/dL compared with measurements at his 2-month visit. A computed tomography scan performed without any contrast agent at that time confirmed the existence of hydronephrosis in both the medial and lateral kidneys. A nephrostography showed a ureteral stricture. Because endoscopic surgery for ureteral dilatation was not successful, the decision was made to perform ureteral repair by the open surgical technique. The short length of the ureters resulted in the lateral renal pelvis being anastomosed to the bladder by flap (Boari flap). The ureter of the patient's native kidney was transected in the middle portion, and the distal ureter was anastomosed to the medial renal pelvis using the end-to-end method. Here, we showed that, despite limited experiences with pediatric donors, en bloc kidney transplant can be performed under the guidance of experienced surgical techniques and precise postoperative follow-up.

The role of serum and urinary carbohydrate antigen 19-9 in predicting renal injury associated with ureteral stone.

This study was designed to evaluate the role of urinary and serum carbohydrate antigen 19-9 (CA19-9) as a biomarker in the assessment of patients with ureteral stone. A total of 38 patients with ureteral stone and hydronephrosis who underwent transurethral lithotripsy (TUL) (Group A) and 24 age-matched healthy controls (Group B) were evaluated in this study. Urinary and serum CA19-9 concentrations were measured in group A patients before TUL as well as 4 and 8 weeks following the operation. Urinary and serum CA19-9 concentrations were also measured in group B participants. Median concentration of urinary and serum CA19-9 was 34.0 and 15.0 kU/L in group A patients and 16.1 and 5.3 kU/L in group B, respectively (p < 0.001). Medians of CA19-9 concentration in urine and serum reduced to 12.5 and 4.5 kU/L 8 weeks after TUL (p < 0.001). Following successful TUL and hydronephrosis resolution, a significant decline was detected in serum and urinary CA19-9. We also noted that duration of ureteral obstruction was associated with serum and urinary CA19-9 concentrations, suggesting the potential role of this marker in predicting renal damage associated with urinary tract obstruction and determining the appropriate timing of interventions.

A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women.

OBJECTIVE: To compare the efficacy of sustained-release (SR) bupropion to placebo in treating hypoactive sexual desire disorder (HSDD) in ovulating women. PATIENTS AND METHODS: After a 1-week, placebo lead-in phase, 232 treatment-seeking women with regular menstrual cycles were randomly assigned to bupropion SR 150 mg/daily (116) or placebo (116) for 12 weeks under double-blind conditions. Efficacy was assessed with the Brief Index of Sexual Functioning for Women (BISF-W), the Personal Distress Scale (PDS), the global efficacy question (GEQ; 'Did the treatment you received during the 12-week improve meaningful your sexual desire?') and overall patient satisfaction question ('Are you satisfied with the efficacy of your treatment?'). RESULTS: The mean (sd) composite score on the BISF-W, increased from 15.8 (2.6) and 15.5 (2.2) at baseline to 33.9 (4.2) and 16.9 (2.6) in the bupropion and placebo groups, respectively (P= 0.001). The odds ratio (95% confidence interval) for response in the bupropion group relative to placebo was 3.2 (2.1-6.3). The thoughts/desire score more than doubled in patients treated with bupropion (P= 0.001). At the 12-week evaluation the reduction in the PDS scale was 29.4% in bupropion and 4.7% in the placebo group (P= 0.01). In response to the GEQ, of patients in the bupropion and placebo groups, 65.3%, and 4.3%, respectively, responded 'Definitely yes' (P= 0.001). Of patients in the bupropion and placebo groups, 71.8%, and 3.7%, respectively, were definitely satisfied with the efficacy of their treatment, (P= 0.001). After 12 weeks of treatment, 82 women (78.1%) in the bupropion and five (4.9%) in the placebo group were willing to continue therapy (P= 0.001). CONCLUSIONS: The results from this study indicate that bupropion SR is an effective and well-tolerated treatment for HSDD in ovulating women. Further controlled trials are warranted.

A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease.

OBJECTIVE: To analyse the safety and efficacy of pentoxifylline sustained-release (PTX-SR) treatment in patients with early chronic Peyronie's disease (PD). PATIENTS AND METHODS: In all, 228 patients with a mean (sd) age of 51 (9) years who had early chronic PD were randomized to receive 400 mg PTX-SR (Apo-Pentoxifylline, Apotex Inc., Toronto, Canada) twice daily (group 1, 114) or similar regimen of placebo (group 2, 114) for 6 months. A medical history was taken and the men had a complete physical examination. The following variables were assessed before and after therapy: penile curvature and penile artery spectral traces (end-diastolic velocity, EDV, peak systolic velocity, PSV, and resistivity index, RI, of the right and left cavernous arteries assessed with dynamic penile duplex ultrasonography), plaque characteristics (assessed by penile X-ray and penile ultrasonography), pain (assessed by visual analogue scale), erectile function (assessed by the International Index of Erectile Function, IIEF questionnaire), treatment satisfaction (assessed by Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire), and side-effects. Patient perception of penile curvature and plaque size, and mean weekly intercourse attempts were also assessed. RESULTS: Overall, 36.9% of patients who received PTX-SR reported a positive response, vs only 4.5% in the placebo group. Of patients in PTX-SR group, 12 (11%) had disease progression, vs 46 (42%) in placebo group (P = 0.01). Improvement in penile curvature (P = 0.01), and plaque volume (P = 0.001) was significantly greater in patients treated with PTX-SR than placebo. The increase in IIEF total score was significantly higher in the PTX-SR group (P = 0.02). Mean PSV changes after therapy compared to baseline were statistically significant between PTX-SR (right, +11.4%, left, +11.7%) and placebo-treated (+0.2% and -4.2%, respectively) patients (both P = 0.04). CONCLUSIONS: PTX-R was moderately effective in reducing penile curvature and plaque volume in patients with early chronic PD. Further studies with different treatment regimens are needed to better elucidate the beneficial effects of PTX-SR in PD.

Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men.

BACKGROUND & AIMS: Fatty acid (FA) composition of the spermatozoa may be an important determinant of fertility. The aim was to evaluate polyunsaturated fatty acid (PUFA) composition of the blood plasma and spermatozoa in infertile men with idiopathic oligoasthenoteratozoospermia (OAT). METHODS: Eighty-two infertile men with idiopathic OAT and seventy-eight fertile men defined according to semen concentration and proven fertility were enrolled in the study. The semen parameters were assessed according to World Health Organization criteria; three omega-3 fatty acids--alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and two omega-6 fatty acids--linoleic acid (LA) and arachidonic acid (AA) concentrations were measured in blood plasma and spermatozoa; and the seminal plasma enzymatic antioxidant levels of catalase, and superoxide dismutase (SOD) were also assessed. RESULTS: Proven fertile men had higher blood and spermatozoa levels of omega-3 FAs compared with the infertile patients. The ratio of serum omega-6/omega-3 fatty acids was significantly higher in infertile (14.8+/-4.3) patients compared to fertile controls (6.3+/-2.2) (P=0.001). Additionally, levels of AA were higher and the omega-3 index (EPA+DHA) was lower in infertile subjects than in fertile controls (all P values<0.05). Infertile men had higher mean AA:DHA ratio and AA:EPA (6.4+/-2.9 and 12.0+/-4.9, respectively) than fertile men (3.3+/-1.8 and 6.7+/-2.6, respectively) (both P=0.001). A strong negative correlation was found between the AA:DHA and AA:EPA ratios and total sperm count (r=-0.62, P=0.001 and r=-0.64, P=0.001, respectively), sperm motility (r=-0.63, P=0.001 and r=-0.61, P=0.001, respectively), and sperm morphology (r=-0.61, P=0.001, and r=-0.59, P=0.002, respectively). CONCLUSIONS: Infertile men had lower concentrations of omega-3 FAs in spermatozoa than fertile men. These results suggest that research should be performed to assess the potential benefits of omega-3 FA supplementation as a therapeutic approach in infertile men with idiopathic OAT.

Modified ureteroneocystostomy in kidney transplantation to facilitate endoscopic management of subsequent urological complications.

OBJECTIVES: Urological complications in kidney transplant patients are among serious complications. Endourology has allowed for a less-invasive approach to dealing with these transplant complications. Access to the upper urinary tract in traditionally anterior extravesical ureteroneocystostomy is usually difficult if not impossible. MATERIALS AND METHODS: We evaluated the results of renal transplantation comparing two techniques of anterior extravesical ureteroneocystostomy (AEVUNC) and posterolateral extravesical ureteroneocystostomy (PLEVUNC). A total of 120 transplant recipients were randomized to either PLEVUNC (group 1, n = 61) or AEVUNC (group 2, n = 59) techniques. Ureteral and nonureteral complications were compared at 36- to 51-month follow-up. The data regarding successful ureteroscopy were also gathered. RESULTS: The PLEVUNC group had a urological complication rate of 27.9%, which did not significantly differ from those in AEVUNC group (26.1%) (P = 0.1). In the PLEVUNC group, 1- and 3-year graft survivals were 92.6 and 85.2%, respectively, whereas in the AEVUNC group they were 92.3 and 82.7%, respectively (P = 0.08). There were no significant differences between urinary tract infections, delayed graft function, and chronic allograft nephropathy between the two groups (P = 0.1, 0.1 and 0.08, respectively). Three patients (5.6%) in PLEVUNC group and 1 (1.9%) in AEVUNC group developed immediate postoperative hydronephrosis after removal of ureteral stent (P = 0.04). Successful ureteroscopy was achieved in 52 (96.3%), and 39 (75%), of patients in PLEVUNC and AEVUNC groups, respectively (P = 0.001). CONCLUSIONS: Easy and safe access to the upper urinary tract in transplant recipients can be achieved using a PLEVUNC technique. This facilitates the endoscopic procedures in the case of urological complications and disorders.